Detailed Information

NPI Number 1033371463 has the “Individual” type of ownership and has been
registered to the following primary business legal name (which is a provider name or healthcare organization name) — SURESH REDDY MEREDDY M.D..
Records indicate that the provider gender is “Male”.
The enumeration date of this NPI Number is 06/26/2008.
NPI Numer information was last updated at 07/17/2009.

The provider is physically located (Business Practice Location) at:

1600 11TH ST
WICHITA FALLS
, TX
76301-4300
US

The provider can be reached at his practice location using the following numbers:

Phone 970-764-3983Fax 940-764-3978

The provider's official mailing address is:

5410 MARYLAND WAY
SUITE 300
BRENTWOOD
, TN
37027-5064
US

The contact numbers associated with the mailing address are:

Phone 615-377-5652Fax 888-241-1404

The authorized official registered with the “1033371463” NPI Number
is .

The authorized official title (position) is .

You can reach the authorized official at the following phone number .

Scope of Practice

The following information about the speciality of the provider is available:

#

Taxonomy Code

Taxonomy

License Number

License Number State

1

207R00000X

Internal Medicine

N0973

TX

Legacy Identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

A sole proprietor is the sole (the only) owner of a business that is not incorporated; that unincorporated business is a sole proprietorship.

In a sole proprietorship, the sole proprietor owns all of the assets of the business and is solely liable for all of the debts of the business.

There is no difference between a sole proprietorship and a sole proprietor; they are legally a single entity: an individual.

In terms of NPI assignment, a sole proprietor is an Entity type 1 (Individual) and is eligible for only one NPI (the sole proprietorship business is not eligible for its own NPI).

As an individual, a sole proprietorship cannot be a subpart and cannot have subparts. (See NPI Final Rule for information about subparts.)

A sole proprietorship may or may not have employees.

Often, the IRS assigns an EIN to a sole proprietorship in order to protect the sole proprietor's SSN from disclosure in claims or on W-2s. NPPES does not capture a sole proprietorship's EIN.

Many types of health care providers could be sole proprietorships (for example, group practices, pharmacies, home health agencies).

4

Provider Last Name (Legal Name)

MEREDDY

The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.

5

Provider First Name

SURESH

The first name of the provider, if the provider is an individual.

6

Provider Middle Name

REDDY

The middle name of the provider, if the provider is an individual.

7

Provider Credential Text

M.D.

The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

8

Provider First Line Business Mailing Address

5410 MARYLAND WAY

The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.

9

Provider Second Line Business Mailing Address

SUITE 300

The second line mailing address of the provider being identified. This data element may contain the same information as ''Provider second line location address''.

10

Provider Business Mailing Address City Name

BRENTWOOD

The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.

11

Provider Business Mailing Address State Name

TN

The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.

12

Provider Business Mailing Address Postal Code

37027-5064

The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.

13

Provider Business Mailing Address Country Code

US

The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.

14

Provider Business Mailing Address Telephone Number

615-377-5652

The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''.

15

Provider Business Mailing Address Fax Number

888-241-1404

The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''.

16

Provider First Line Business Practice Location Address

1600 11TH ST

The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

17

Provider Business Practice Location Address City Name

WICHITA FALLS

The city name in the location address of the provider being identified.

18

Provider Business Practice Location Address State Name

TX

The State or Province name in the location address of the provider being identified.

19

Provider Business Practice Location Address Postal Code

76301-4300

The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.

20

Provider Business Practice Location Address Country Code

US

The country code in the location address of the provider being identified.

21

Provider Business Practice Location Address Telephone Number

970-764-3983

The telephone number associated with the location address of the provider being identified.

22

Provider Business Practice Location Address Fax Number

940-764-3978

The fax number associated with the location address of the provider being identified.

23

Provider Enumeration Date

06/26/2008

The date the provider was assigned a unique identifier (assigned an NPI).

24

Last Update Date

07/17/2009

The date that a record was last updated or changed.

25

Provider Gender Code

M

The code designating the provider's gender if the provider is a person.

26

Provider Gender

Male

The provider's gender if the provider is a person.

27

Healthcare Provider Taxonomy Code #1

207R00000X

The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.

28

Healthcare Provider Taxonomy 1

Internal Medicine

Healthcare Provider Taxonomy #1

29

Provider License Number 1

N0973

Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.

30

Provider License Number State Code 1

TX

Provider License Number State Code #1

31

Healthcare Provider Primary Taxonomy Switch 1

Y

Primary Taxonomy:

X - The primary taxonomy switch is Not Answered;

Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);

N - The taxonomy is not the primary taxonomy.

32

Other Provider Identifier 1

8AN226

Other Provider Identifier #1

33

Other Provider Identifier Type 1

OTHER

Other Provider Identifier Type #1

34

Other Provider Identifier State 1

TX

Other Provider Identifier State #1

35

Other Provider Identifier Issuer 1

BCBS OF TX

Other Provider Identifier Issuer #1

36

Other Provider Identifier 2

8L6250

Other Provider Identifier #2

37

Other Provider Identifier Type 2

MEDICARE PIN

Other Provider Identifier Type #2

38

Other Provider Identifier State 2

TX

Other Provider Identifier State #2

39

Other Provider Identifier 3

201334401

Other Provider Identifier #3

40

Other Provider Identifier Type 3

MEDICAID

Other Provider Identifier Type #3

41

Other Provider Identifier State 3

TX

Other Provider Identifier State #3

Driving Directions to “ SURESH REDDY MEREDDY M.D.” Practice Location

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Practice Location

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